Erectile function rehabilitation with phosphodiesterase type 5 inhibitors in patients following nerve-sparing radical prostatectomy: a comparative efficacy analysis of different course lengths

Introduction. Despite the selective patient screening and improvements in surgical techniques for radical prostatectomy (RP), the incidence of erectile dysfunction (ED) remains relatively high. The efficacy of phosphodiesterase type 5 inhibitors (PDE5i) in patients undergoing nerve-sparing RP can vary from 35% to 75%. One of the issues in penile rehabilitation after RP is its duration. Currently, there are no standardised guidelines on the length of PDE5i therapy, with authors providing conflicting and insufficient data to recommend specific timelines for penile rehabilitation. Therefore, further research is required to determine the optimal duration of PDE5i-based rehabilitation.

Objective. To compare the efficacy of long-term PDE-5i administration for restoring erectile function in patients undergoing nerve-sparing RP versus a short 3-month course in the early postoperative period.

Materials & methods. A prospective analysis of data from 81 patients with localized prostate cancer who underwent laparoscopic nerve-sparing RP was carried out. In the postoperative period, patients were divided into two groups using simple randomisation. Group 1 received PDE5i for 11 months as part of penile rehabilitation, while group 2 received them for three months.

Results. The severity of ED three- and 12-months following RP was comparable in both groups. A long-term course of PDE-5i showed no advantages at the one-year stage of the study in terms of erectile function compared to a threemonth therapy course. The same trend was observed in the results of the nocturnal penile tumescence test. In addition to developing irreversible ED, gradual penile shortening after surgery can cause the patient's inability to urinate while standing and, as a result, lead to serious psychological problems. When assessing the penile length in both groups, a tendency towards its shortening at the annual stage of the study was noted, which indicates insufficient effectiveness of both the annual and three-month rehabilitation course with PDE-5i.

Conclusion. Long-term use of PDE-5i compared to a short-term rehabilitation course did not demonstrate any advantages in restoring erectile function one year following nerve-sparing RP.

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